Ohio Medicaid Officials Draw Criticism for Reimbursement Policies

Ohio Medicaid officials have "turned down" about $200 million in federal funding by "declining" seek reimbursement for Medicaid services through schools, the Cleveland Plain Dealer reports. Federal Medicaid Funds will help pay for "administrative activities" such as enrolling children in Medicaid or working to develop methods of "delivering health care services to students and their families." Medicaid also pays for physical exams, speech therapy, immunizations and other "direct medical services" that schools provide to children in poor families. Since 1997, the Medicaid office in the Ohio Department of Job & Family Services has "rejected" requests from 225 school districts to seek reimbursement through the programs. Until recently, Ohio Medicaid Director Barbara Edwards has even "refus[ed]" to file "placeholder claims," which would "hold a school district's place in line, meaning that the government will pay the claims retroactively," the Plain Dealer reports. Edwards' "opposition" to the provision of school-based Medicaid services "stem[s]" from a federal General Accounting Office report that found that some Michigan schools had "improperly billed" the program and "accepted gratuities" from Deloitte Consulting, a contractor hired to file their Medicaid claims. Edwards said that Ohio officials were "alarmed" by the report, which resulted in the federal government denying $100 million in claims to Michigan schools. Last week, despite her concerns about the program, Edwards allowed her department to file for $9.8 million in services provided by schools between April and June 1999. But state Sen. Eric Fingerhut (D) said, "I just think this is an example of (the agency's) incompetence. They've just completely dropped the ball. You have school districts making claims to them and they just sit on them. This is money that other states are accessing for their students." For her part, Edwards said, "We've moved cautiously, but people need to understand that Medicaid money isn't free money. It comes with expectations, and we have to be accountable to the federal government."

Contractor Controversy
The Plain Dealer reports that only about one-third of Ohio's school districts have filed claims with the state because of the "volume and complexity of the paperwork" required. Participating systems generally hire a private contractor to file the claims. Edwards has criticized the school districts for agreeing to pay Deloitte 20% of what they will receive in reimbursements. Deloitte could earn $10 million per year if all Ohio schools filed claims, the Plain Dealer reports. Jeff Simering of the Council of Great City Schools, said, "I'm not happy with 20%. But 80% of something is better than 100% of nothing" (Wendling, Cleveland Plain Dealer, 7/1).